What Is Non-Hormonal Birth Control and How to Use It?

You may think that most forms of birth control used by women would have hormones. Think again.

A non-hormonal birth control option called Phexxi, made by the company Evofem Biosciences, was approved by the FDA in 2020. One of the product’s commercials takes place inside the vagina (yes!) of “Schitt’s Creek” actress Annie Murphy. The ad is set up to look like a luxurious bedroom where Murphy is seen lounging around and waiting for, ahem, fun.

How does Phexxi work? Well, Phexxi prevents pregnancy by changing the vagina’s pH. A healthy vaginal pH ranges from 3.8 to 4.5. When a couple is trying to conceive, the sperm will enter the vagina and increase the vagina’s pH, making it a more hospitable environment for the sperm. This makes it easier for the sperm to enter the cervical canal and possibly lead to a pregnancy.

Phexxi is a gel that contains lactic acid, citric acid and potassium bitartrate. When Phexxi is used in the vagina, it keeps the vaginal pH acidic. This helps to prevent sperm from moving to the cervix, and then the uterus, to reach an egg.

“The sperm never reach the egg to fertilize it because they are unable to get past the vagina,” says Dr. Megan Gray, an OB/GYN with Orlando Health Physician Associates in Orlando, Florida.

Users of Phexxi place the gel via an applicator into the vagina up to an hour before they plan to have sex.

This form of non-hormonal birth control is available by prescription. Without insurance, the cost of Phexxi is around $270 for 12 applicators. Each applicator has one use. The manufacturer’s website has some discount coupons for users with private insurance. The cost will vary if you have insurance.

[See: 11 Things Your OB-GYN Wants You to Know.]

Phexxi’s Effectiveness

When it’s used perfectly — meaning always used before sex, and used within that one-hour window of time — Phexxi’s effectiveness rate is 93%. When not used perfectly, it’s 86% effective, according to Planned Parenthood. In other words, 14 out of 100 users would get pregnant using Phexxi and no other birth control methods.

You can increase the effectiveness of Phexxi by using other birth control methods along with it, such as condoms or a diaphragm.

To give some comparison, here are the effectiveness rates for some other forms of birth control, according to the American College of Obstetricians and Gynecologists:

Most effective: A birth control implant, an IUD or sterilization. Among 100 women, these methods will lead to less than one pregnancy a year.

Medium effectiveness: A birth control injection, pill or patch; a vaginal ring, or diaphragm. These methods will lead to 6 to 12 pregnancies for every 100 women who use them, according to ACOG.

Least effectiveness: A male condom, female condom, cervical cap, sponge, fertility awareness-based methods and spermicide. These are associated with 18 or more pregnancies in a year for women using them.

[READ: Tips for Better Vaginal Health.]

Who May Want to Use Phexxi?

One advantage of Phexxi is that it increases the number of birth control options available, says Dr. G. Thomas Ruiz, OB/GYN lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California. But that doesn’t mean it’s for everyone.

Phexxi may appeal to women who want to avoid hormonal birth control. There could be different reasons why this is important to them:

— They find that hormonal birth control has unpleasant side effects for them, such as mood changes, unpredictable bleeding and lower libido, says Dr. Chidera Ejiogu, an OB/GYN with UTHealth Houston and Memorial Hermann Hospital.

— They can’t use hormonal birth control because of another health condition, such as high blood pressure or blood clots, says Dr. Rachel Jensen, a resident with the University of Maryland School of Medicine’s Division of Obstetrics, Gynecology, and Reproductive Sciences in Baltimore. Hormonal birth control can raise the risk for higher blood pressure or blood clots. One in 3,000 women using birth control pills will develop a blood clot annually, according to the National Blood Clot Alliance. That may be a relatively small number, but it puts women already prone to blood clots at an even higher risk.

— They are looking to take a break from hormonal birth control, such as the pill. There isn’t a medical reason to do this, but Ruiz has some patients who have expressed this preference.

— They smoke. Smoking and using hormonal birth control can raise the risk for blood clots.

Here are some patients who may find Phexxi to be a good choice for them:

— A woman in her mid-40s who smokes and has a long-distance partner whom she sees occasionally. It could also be that she, or her partner, dislikes using condoms. Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive services at Yale University in New Haven, Connecticut, sees this person as a potential Phexxi user because she has a lower (although not zero) chance of getting pregnant due to her age. Plus, she shouldn’t use birth control pills because she smokes.

— A new mom who’s breastfeeding. At the same time, this person would be OK with an unplanned pregnancy, Minkin says. It isn’t known if Phexxi will enter breastmilk, according to the package insert. However, it appears to be safe for this patient group, according to OB/GYNs interviewed for this article.

— A woman who may not be able to use other forms of birth control. For instance, she dislikes IUDs due to cramping, and she wants to avoid hormonal-based birth control such as the pill.

— A woman using birth control pills who wants to add another type of protection against pregnancy. “However, most people who are attracted to this contraceptive are usually desiring to avoid hormones,” Gray points out.

Who Should Avoid Phexxi?

Women who aren’t ideal for Phexxi are those who:

— Also want protection against sexually transmitted infections. Condoms are the only birth control that protects against both pregnancy and STIs.

— Have frequent urinary tract infections, or have urinary tract or kidney disorders. Phexxi’s packaging recommends that women with urinary tract or kidney disorders avoid Phexxi. That’s because of the small chance that more UTIs or kidney infections could occur with use of the product.

— Would be strongly against becoming pregnant.

— May forget to use Phexxi in the one-hour time window before sex.

— Want to continue using a vaginal ring. While Phexxi can be used at the same time as certain other birth control methods, such as condoms, it can’t be used at the same time as a vaginal ring, Jensen says. This is because vaginal rings are typically made with flexible silicone rubber embedded with contraceptive hormones. The Phexxi gel would break down the silicon material, Ruiz explains.

Non-Hormonal Birth Control Options

While it may be the only non-hormonal birth control gel, Phexxi is not the only form of non-hormonal birth control available. Other options include:

— Copper IUDs. This type of IUD is different from the standard ones that contain hormones. Some women, however, dislike copper IUDs because it makes their periods heavier, Ruiz says.

— Cervical caps. This is a small cap shaped like a sailor’s hat that’s inserted deep into the vagina to cover the cervix and help prevent pregnancy.

— Condoms, including male condoms and female condoms.

— Diaphragms.

— Sponges.

[READ: What Are the Early Signs of Cervical Cancer?]

Phexxi Side Effects

Just like any form of birth control, Phexxi is associated with some side effects. These side effects aren’t common, but they include:

— Burning and irritation where the gel is inserted. This occurs in about 2% of patients.

— Bacterial vaginosis.

— Pain when urinating.

— Vaginal discharge.

— A yeast infection.

Occasionally, the male partner also may experience some genital burning or discomfort from Phexxi.

More serious side effects, such as a urinary tract infection or kidney infection, occur in about 0.36% of users.

If you think you’re having an allergic reaction to Phexxi, seek immediate medical attention, Ejiogu cautions. Signs of an allergic reaction include:

— Irritation where inserted.

— Loss of consciousness.

— Redness.

— Shortness of breath.

Some Final Notes

Here are some final reminders when considering Phexxi as a birth control option:

— If you plan to have sex after the initial one-hour window or you’re going to have sex again, you need to insert the gel again.

— Phexxi isn’t intended to work outside of the initial one-hour time window.

— You can still use Phexxi on your period.

— If you have sex more than once within an hour, you need to insert Phexxi again.

— It doesn’t work if it’s used after sex.

— It’s OK to use Phexxi while using other vaginal medications to treat yeast infections.

— Phexxi won’t protect against STIs like HIV, hepatitis, syphilis and others.

— You can use Phexxi with other birth control methods, including condoms and the pill. However, don’t use it while also using a vaginal ring.

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What Is Non-Hormonal Birth Control and How to Use It? originally appeared on usnews.com

Update 10/20/22: This story was previously published at an earlier date and has been updated with new information.

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